Prescriber's Guide

6th Edition - 9781316618134

This new edition features seven new compounds as well as information about several new formulations of existing drugs. Many important new indications are covered for existing drugs, as are updates to the profiles of the entire content and collection, including an expansion of the sections on long-acting injectable formulations of antipsychotics.

If 2 or more antipsychotic monotherapies do not work, consider clozapine

Best Augmenting Combos for Partial Response or Treatment Resistance

Augmentation of conventional antipsychotics has not been systematically studied

Addition of a mood-stabilizing anticonvulsant such as valproate, carbamazepine, or lamotrigine may be helpful in both schizophrenia and bipolar mania

Augmentation with lithium in bipolar mania may be helpful

Addition of a benzodiazepine, especially short-term for agitation

Tests

Since conventional antipsychotics are frequently associated with weight gain, before starting treatment, weigh all patients and determine if the patient is already overweight (BMI 25.0–29.9) or obese (BMI ≥30)

Consider monitoring fasting triglycerides monthly for several months in patients at high risk for metabolic complications and when initiating or switching antipsychotics

While giving a drug to a patient who has gained >5% of initial weight, consider evaluating for the presence of pre-diabetes, diabetes, or dyslipidemia, or consider switching to a different antipsychotic

Should check blood pressure in the elderly before starting and for the first few weeks

Monitoring elevated prolactin levels of dubious clinical benefit

Phenothiazines may cause false-positive phenylketonuria results

Patients with low white blood cell count (WBC) or history of drug-induced leucopenia/neutropenia should have complete blood count (CBC) monitored frequently during the first few months and pipothiazine should be discontinued at the first sign of decline of WBC in the absence of other causative factors